Recently, it came to light that Steven Jobs, Apple's CEO, received a liver transplant. There exist some concerns for those who worry about corporate disclosure issues and health privacy for CEOs but the transplant also raised again the troubling issue about how organs are distributed in this country. The Chicago Tribune has a brief report containing an interview with Professor Arthur Caplan. Greg Burns writes,

If Apple Inc. co-founder Steve Jobs used his
billions to obtain a new liver ahead of less-privileged transplant
patients, who's to blame?

Not Jobs, says Arthur Caplan at the University of Pennsylvania's Center for Bioethics. "He did nothing illegal. And pursuing his own self-interest makes sense," Caplan said.

Instead, the blame goes to transplant doctors, the United Network
for Organ Sharing and Congressional leaders. They have failed to
cut off an inside track that the rich, famous and gravely ill can
follow to snare a spare part ahead of everybody else. . . .

For Caplan's take on how the Silicon Valley chieftain wound up in Memphis for a new liver, click here.

Another bizarre turn in the story came today when Dr. James Eason,
the head of the hospital's transplant unit, held a press conference to
address the subject, telling reporters, "Mr. Jobs is doing fine."

The hospital held the conference, in part, to address criticism that
Jobs's position had helped him climb to the top of the transplant list.
Said Eason,

Whoever's at the top of the list, they're there because
they're the sickest. Waiting time isn't even a factor anymore. If
someone's been on the list a long time, they're obviously healthy
enough to have survived for a long time" and therefore by definition
might not be the best candidate.

A sharply divided federal appeals court ruled constitutional yesterday
a Virginia law banning "partial birth" abortion that was overturned
four years ago, bringing the state in line with a federal ban on the
controversial procedure.

A three-judge panel of the U.S. Court of Appeals for the 4th Circuit
overturned the Virginia law in 2005 by a 2 to 1 vote, finding that it
did not allow for exceptions to safeguard a woman's health. The Supreme
Court ordered the appeals judges to revisit the issue when it upheld
the Partial Birth Abortion Ban Act two years ago, a law passed by
Congress in 2003 that is similar to Virginia's ban.

Although the Virginia law permits women to choose various abortion
procedures, it specifically makes it a crime for doctors to perform a
rare midterm abortion that involves partially delivering the fetus
before crushing its skull to ease removal.

William G. Fitzhugh, a Richmond doctor who challenged the law,
argued that the procedure can be necessary to protect the life of a
patient and that banning it could prevent doctors from performing legal
procedures out of a fear of prosecution. Opponents of the procedure
liken it to infanticide. . . .

Today National Public Ratio began a new series discussing the lobbyists in the room during health reform debates.

Earlier this month, lobbyists trooped in
to watch as the Senate Committee on Health, Education, Labor and
Pensions began working on a health-care overhaul — the first
congressional panel this year to move so far.

As the lobbyists
watched the 22 senators, NPR watched the lobbyists — took panoramic
photos of them, in fact. After all, congressional committee meetings
like this one are public events.

We wanted to know how many
lobbyists go to these important sessions, what they hope to influence
and, most basically, who they are. We've already begun to identify
them; you can see the panoramic shot by clicking on the image at left. . .

NPR is asking for some help identifying these lobbyists. If you check out the photos on their website and know the players, you may want to provide them with some information.

Dr. Jerri Nielsen FitzGerald, who diagnosed
and treated her own breast cancer before a dramatic rescue from the
South Pole, has died. She was 57. Her husband, Thomas
FitzGerald, said she died Tuesday at their home in Southwick, Mass. Her
cancer had been in remission until it returned in August 2005, he said
Wednesday.

She was the only doctor among 41 staff at the
National Science Foundation's Amundsen-Scott South Pole Station in
winter 1999 when she discovered a lump in her breast. At first, she
didn't tell anyone, but the burden became too much to bear. . . . Rescue
was out of the question. Because of the extreme weather conditions, the
station is closed to the outside world for the winter. She had no
choice but to treat the disease herself, with help from colleagues she
trained to care for her and U.S.-based doctors she stayed in touch with
via satellite e-mail. . . .

Nielsen FitzGerald spent the last decade speaking
around the world about the cancer and how it changed her life, and also
worked as roving ER doctor in hospitals all over the Northeast. "She
fought bravely, she was able to make the best of what life and
circumstance gave her, and she had the most resilience I have ever seen
in anyone," said her husband. "She fought hard and she fought
valiantly." The couple would have celebrated their third anniversary
next week. . . .

The Wall Street Journal reports on some concerns of state governors about expanding Medicaid. Jonathan Weisman writes:

Some governors are pushing to scale back or kill proposals to expand Medicaid to provide health-care coverage to the uninsured, raising a new challenge to President Barack Obama's effort to overhaul the system.

Medicaid, the health-care program for the poor, is funded through a combination of federal and state tax money. Proposals in the House and Senate would expand the program to cover at least a third of the nation's 46 million uninsured, but states are worried they would get stuck with a big part of the tab. . . .

Sen. Diane Feinstein, a California Democrat, said Sunday the issue could be a deal breaker for her. California is in "a state of financial catastrophe," she said on CNN's "State of the Union." "[I]f you change the Medicaid rate, for example, it has an impact on California between $1 billion and $5 billion a year. Now, how could I support that?" she asked. "It would take down the state."

Currently, government-sponsored coverage of children offered by a combination of Medicaid and the State Children's Health-Insurance Program generally extends to 200% of the poverty line, or $36,620 for a family of three, $44,100 for a family of four. Parents are generally covered by Medicaid up to 67% of the poverty line, or $14,800 for a family of four. Adults without dependent children often aren't covered by Medicaid at all.

The House Democratic plan would offer coverage to any uninsured American with incomes up to 133% of the poverty line, with the federal government assuming all the cost of expansion. Proponents haven't said what that will cost. A proposal by the Senate Health, Education, Labor and Pensions Committee may go up to 150% of the poverty line. The federal government would assume all the cost for five years. During the next five years, the states would gradually assume half the cost. The Senate Finance Committee is working on legislation along the same lines, but not as generous. Pregnant women would be covered up to 150% of the poverty line. Childless adults could be closer to 115%, a senior committee aide said.

White House officials appear to be looking at other options for the uninsured poor. . . .

Ezra Klein discusses rationing of health care and why we don't have to be like the British. He writes,

Michael Hiltzik has a smart column explaining the way rationing works in the British health-care system:

The most extensive laboratory in the field has been run by the National Institute for Health and Clinical Effectiveness, or NICE, an arm of Britain's National Health Service, the government healthcare program.

NICE's judgments about cost-effectiveness are based on a measure known as the quality-adjusted life year, or QALY. Get used to the acronym -- you're sure to hear it a lot more as the health-reform debate rages on.

In simple terms, QALY adjusts the length of time that a treatment might extend a patient's life by a factor assessing the patient's quality of life in that time ranging from 0 (death) to 1 (complete health). If a certain cancer drug would extend life by two years, say, but with such onerous side effects that those years were judged to be only half as worth living as those of a healthy person, the QALY is 1. . . .

The big problem with Britain is that there's nothing outside the National Health Service. If you want to pay for care out of your own pocket, you have to give up your state-based coverage. There's no reason we have to copy that example. But imagine a system in which the government offered basic coverage to all Americans, regardless of age or income, for all treatments that are less than $33,000 per QALY. Above that, the government could offer subsidies for low-income Americans to purchase supplementary coverage, and higher-income folks would have to figure it out on their own.

That's not rationing, incidentally. It's simply setting limits on what comes out of the public purse. . . . Indeed, this is basically what the French do, and many people think their health-care system is the best in the world.

Nate Silver at the FiveThirtyEight blog has crunched some numbers on the impact of health lobbying money on the public health option. He concludes that such monetary influence does have an impact on several senators and their votes on the public option. He writes,

As I lamented yesterday, health care is one of those areas where both popular opinion and sound public policy seem to take a backseat to protecting those stakeholders who benefit from the status quo. But can we actually see -- statistically -- the impact of lobbying by the insurance industry on the prospects for health care reform? I believe that the answer is yes. . . .

What happens if we set the lobbying variable to zero for all senators? That is, suppose that the health care insurance industry were prohibited from making political contributions? In that case, the model predicts, 47 senators would currently support the public option, as opposed to the 38 who actually do. In other words, the insurance industry's influence appears to swing about 9 votes against the public option. Whatever number of senators wind up supporting the public option, add 9 to it, and you'll have a decent ballpark estimate for what the level of support might be if not for insurance industry contributions. Note, however, that we haven't attempted to model the impact of contributions from other interest groups, including both pro-health reform organizations such as labor unions or other stakeholders like pharmaceutical companies. . .

The whole article is a great read and I enjoy Nate Silver's ability to provide such clarity to his research methods and results. Thanks to HuffingtonPost.com for the site.

The Associated Press reports on the new deal that the drug companies have negotiated with Medicare's drug provision. The story provides,

President Barack Obama on Monday welcomed the pharmaceutical
industry's agreement to help close a gap in Medicare's drug coverage,
calling the pact a step forward in the push for overhaul of the
nation's health care system. Obama said that drug companies have
pledged to spend $80 billion over the next decade to help reduce the
cost of drugs for seniors and pay for a portion of Obama's health care
legislation. . . .

Obama
said the move on Medicare will help correct an anomaly in the program
that provides a prescription drug benefit through the government health
care program for the elderly and disabled. Under the deal, drug
companies will pay part of the cost of brand name drugs for lower and
middle-income older people in the so-called "doughnut hole." That term
refers to a feature of the current drug program that requires
beneficiaries to pay the entire cost of prescriptions after initial
coverage is exhausted but before catastrophic coverage begins. . . .

ThinkProgress provides a helpful chart of the differing health reform plans. the Senate Finance Draft, the Tri House Bill, and HELP Bill current being considered in Congress. Here is a brief discussion of the Tri House Bill and you can see the comparison chart by clicking through to ThinkProgress.

Today, three separate House committees — Ways and Means Committee,
Energy and Commerce Committee, Education and Labor Committee — released
a single health care reform bill, the Tri Committee Proposal. In a
press release announcing the legislation, the three panels with
jurisdiction over health policy in the House announced that they had
developed “a single bill that fulfills President Obama’s goals of
reducing health care costs, protecting and increasing consumers’
choices, and guaranteeing access to quality, affordable health care for
all Americans."

Unlike the HELP bill and the draft (leaked) language of the Senate Finance Committee, the Tri-Committee proposal seems to contain a fairly robust public insurance option.
While details are still being worked out, the proposal establishes a
public plan in 2013 that will compete with private insurers, within the
Exchange, on a level playing field. The public option will be required
to abide by all marketing, operations, and rating rules and would
initially be allowed to use Medicare plus rates. After some time, the
plan would have to independently negotiate fees with providers. . . .

The CDC Press Briefing from last week reminds Americans that the H1N1/Swine Flu continues to spread. The briefing transript provides,

In terms of the numbers of infections
that have been laboratory confirmed as H1N1, there are now more than
17,800 of those in the United States, including around 1,600 that have
been hospitalized and 44 that have died. As we have been saying all
along, these numbers are likely an underestimate of the number of cases
that are out there. There are some surveys that indicate that the
amount of disease in the areas that are having activity with H1N1 is
perhaps around 7% of the population reporting symptoms due to
influenza-like illness. The virus continues to impact mostly younger
people. So far it is not causing significant illness and death in the
elderly like we would see with seasonal influenza. And the symptoms
that are being reported are consistent with influenza, that being
predominantly fever, cough, some shortness of breath, fatigue and
chills. There is some vomiting and diarrhea that have been associated
with cases of this infection. Everyone needs to be alert to the
symptoms of the illness, and especially if you have underlying
conditions, such as asthma, diabetes and heart disease. For those
folks, they need to be vigilant about their symptoms and consult their
doctors or health care providers early if they develop flu-like
symptoms. All of the evidence so far indicates that antiviral drugs
still work. The inhibitors work particularly well. And we are
recommending that they be used in high-risk patients that are sick and
also in those being hospitalized and those that have severe illness.